Week 3: Day 4: Pulmonology by Heidi Pang

During today’s morning meeting, we had an IM resident presented on pancreatitis. He focused on the evaluation of acute pancreatitis since it’s a medical emergency.  I will try to summarize the main points of the presentation:

-          Use CT scan to diagnose, also use w/ contrast

-          Important to know if there’s necrosis (may lead to peritonitis). Use endoscopy to visualize CBD

-          2 main causes of acute pancreatitis: 1 and 2 covered 70% of the cases

1.      Mechanical: for example Gallstone (most important to look for ones caused by ERCP)

2.       Toxicity: Alcohol

3.       Less common – Metabolism: ↑TG (700+)

-          Signs and symptoms:

1.       Epigastric pain radiating to the back!!!!!

2.       Fever usually only occur to those have pancreatitis due to mechanical cause

3.       HIGH MORTALITY rate if patient has PERITONITIS

-          COMMONLY PANCREATITIS ISN’T THE PRIMARY DISESASE!!

1.       DDx: *biliary disease, intestinal obstruction, mesenteric ischemic, *inferior MI, AAA, *distal aortic dissection, PUD

-          Evaluation:

1.       Lipase ↑ (more specific and sensitive than amylase)

2.       Amylase

3.       ALT – 3x normal = gallstone obstruction

4.       Ranson’s Criteria (Check during admission and one after 48 hours)

-          For Chronic pancreatitis: CT scan may show more stones

We did not get to rotate with the thoracic surgeon in the afternoon as he is still on leave for another week. Instead, I had the opportunity to spend the afternoon at the OB/GYN outpatient clinic with 董医师for a couple of hours. She mentioned that Taiwan, patient often refuse often treatment at around menopause, even when the government has been promoting it and emphasize that treatment is free. She estimated that ~50% of patients still refuse such treatment. PAP smear and mammogram are mostly free but examination rate remains at around 30-40%. If patient chooses to accept oral contraceptive, rarely will anyone choose to stay on Rx for over 1 year (mostly 1-3 mo at a time). By the way, did I mention that PAP smear only costs NTD300 for self-pay patients?

I had the opportunity to observe a HSG procedure (hysterosalpingography). Patient was a 31 y/o female with infrequent MC. HSG is usually performed during follicular phase of MC. Radioactive contrast medium is injected into the uterine cavity through the vagina and cervix. We did run into some difficulty during the HSG procedure, as the radiologist were not able to get a good picture of one side of the patient’s fallopian tube and ovary (I believe that they have tried different views at least 5 times). Dr Dong explained that it might indicate that the patient has a true obstruction at the beginning of the tube so the dye was not able to penetrate through. I also had the chance to watch a couple of ultrasound examination, PAP and palpated a 9cm cyst!!!! Today was a very unique experience for sure.